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Huang S, Yang J, Li X, Tang X, Ji T. A novel non-invasive electromagnetic extendable intercalary endoprosthesis: a proof-of-concept study. Front Bioeng Biotechnol 2024; 12:1400428. [PMID: 39091970 PMCID: PMC11291365 DOI: 10.3389/fbioe.2024.1400428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction: Femur and tibia are the most commonly affected sites for primary malignant bone tumors in children. The wide resection of the tumor frequently requires the physis to be resected. The normal growth of the unaffected limb will result in a significant limb length discrepancy at skeletal maturity. To compensate for this resulting LLD, different generations of extendible endoprostheses have been developed. Non-invasive extendable prostheses eliminate the need for surgical procedures and general anesthesia, enabling gradual and painless lengthening. Currently available non-invasive extendable prostheses focus on joint reconstruction, and no case series analysis of intercalary non-invasive extendable prosthesis has been reported. Therefore, we have designed a novel non-invasive electromagnetic extendable intercalary endoprosthesis. Methods: In vitro mechanical experiments and in vivo animal experiments were conducted. Results: In vitro experiments have confirmed that the prosthetics can extend at a constant rate, increasing by 4.4 mm every 10 min. The average maximum extension force during prosthetic elongation can reach 1306N. In animal in vivo experiments, the extension process is smooth and non-invasive, and the sheep is in a comfortable state. Discussion: The in vitro and in vivo animal studies provide evidence to support the extension reliability, laying the foundation for future large-scale validation experiments.
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Affiliation(s)
- Siyi Huang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
| | - Jiake Yang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
| | - Xinyu Li
- Beijing AK Medical Co., Ltd., Beijing, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
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Jain M, Ponugoti G, Bhansal S, Goswami N, Shah M. Management of Post-osteomyelitic Large Ulna Defect in a Pediatric Patient. Indian J Orthop 2023; 57:1697-1701. [PMID: 37766952 PMCID: PMC10519894 DOI: 10.1007/s43465-023-00985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Osteomyelitic sequelae in forearm pose challenges in management. Bone resorption leading to gap nonunions is further difficult to manage. We present a case of post-osteomyelitic ulna defect of 16 cm in a 6-year-old boy managed by non-vascularized fibular grafting with simultaneous correction of radius deformity and its functional outcome after 1 year.
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Affiliation(s)
- Meet Jain
- Orthokids Clinic, 7th Floor, Golden Icon, Opp. Medilink Hospital, Nr. Shivranjani Flyover, 132 Feet Ring Rd, Ahmedabad, Gujarat 380015 India
| | - Godhasiri Ponugoti
- Orthokids Clinic, 7th Floor, Golden Icon, Opp. Medilink Hospital, Nr. Shivranjani Flyover, 132 Feet Ring Rd, Ahmedabad, Gujarat 380015 India
| | - Sheenam Bhansal
- Orthokids Clinic, 7th Floor, Golden Icon, Opp. Medilink Hospital, Nr. Shivranjani Flyover, 132 Feet Ring Rd, Ahmedabad, Gujarat 380015 India
| | - Nitingiri Goswami
- Orthokids Clinic, 7th Floor, Golden Icon, Opp. Medilink Hospital, Nr. Shivranjani Flyover, 132 Feet Ring Rd, Ahmedabad, Gujarat 380015 India
| | - Maulin Shah
- Orthokids Clinic, 7th Floor, Golden Icon, Opp. Medilink Hospital, Nr. Shivranjani Flyover, 132 Feet Ring Rd, Ahmedabad, Gujarat 380015 India
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Qi BC, Gao L, Wang J, Ran J. Treatment of pediatric tibial shaft nonunion using ipsilateral free non-vascularized fibular graft. Technol Health Care 2023; 31:783-787. [PMID: 36404560 DOI: 10.3233/thc-220126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although tibial shaft fractures are the third most common long bone fractures in children after the forearm and femur, nonunion of these fractures are rare in the pediatric population. CASE REPORT Despite seldom seen, tibial nonunion is very complex and it is also a devastating complication of tibial fracture especially when infected. Numerous methods have been employed to treat pediatric tibial nonunion, but there is no consensus. Here, we present a case of a child with right tibial shaft fracture nonunion. We treated this patient with ipsilateral free non-vascularized fibular graft. RESULTS Both the nonunion site and fibular donor site united well with good function in the injured extremity and no adverse events. CONCLUSION We recommend the use of ipsilateral free non-vascularized fibular graft for the treatment of pediatric tibial shaft nonunion.
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Affiliation(s)
- Bao-Chang Qi
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Long Gao
- Department of Orthopedic Traumatology, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jian Wang
- Department of Orthopedic Traumatology, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jian Ran
- Department of Orthopedic Traumatology, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Intercalary frozen autografts for reconstruction of bone defects following meta-/diaphyseal tumor resection at the extremities. BMC Musculoskelet Disord 2022; 23:890. [PMID: 36180843 PMCID: PMC9526247 DOI: 10.1186/s12891-022-05840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
For patients with malignant limb tumors, salvage surgery can be achieved using endoprosthesis or biological reconstructions like allograft or autograft. In carefully selected patients, resected bone can be recycled after sterilization using methods like autoclaving, irradiation, pasteurization or freezing with liquid nitrogen. We evaluated the clinical outcome and complications of malignant limb tumors treated with intercalary resection and frozen autograft reconstruction.
Methods
We reviewed 33 patients whose malignant bone tumors were treated by wide resection and reconstruction with recycling liquid nitrogen-treated autografts between 2006 and 2017. Limb function, bone union at the osteotomy site and complications were evaluated. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.
Results
The cohort comprised 16 males and 17 females, with a mean age of 35.4 years (14–76 years). The most common tumor was osteosarcoma (7 cases). Tumors were located in the humerus (5), ulna (1), femur (10) and tibia (17). The mean follow-up was 49.9 months (range 12–127 months). Of the 33 patients, 16 remained disease-free, and 3 were alive with disease. The mean size of the defect after tumor resection was 11.6 cm (range 6–25 cm). Bone union was achieved in 32 patients, with a mean union time of 8.8 months (range 4–18 months). Complications included 1 graft nonunion, 2 infections (1 superficial, 1 deep infection), 1 leg length discrepancy, 2 graft fractures and 3 local recurrences. The mean MSTS score was 87.2% (range 70–100%).
Conclusion
Liquid nitrogen-treated tumor-bearing autograft is an effective option for biological reconstruction after meta-/diaphyseal tumor resection of long bones. This method has excellent clinical outcomes and is especially recommended for patients with no severe osteolytic bone tumors.
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Norrell K, Stanislav D, Sinclair M, Tougas C. Osteochondral Allograft Reconstruction of a Pediatric Distal Humerus Fracture with Articular Bone Loss: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00017. [PMID: 35962734 DOI: 10.2106/jbjs.cc.22.00254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A right hand dominant 10-year-old girl presenting with an open right distal humerus fracture dislocation involving complete medial column bone loss and a >50% trochlea defect was reconstructed with a size-matched, fresh distal humerus osteochondral allograft. Successful bony integration and functional elbow range of motion were achieved. CONCLUSION A paucity of literature exists to guide the treatment of pediatric distal humerus fractures with significant bone loss. Despite complications associated with osteochondral allografts, they provide a reasonable treatment option to preserve elbow motion in children with unreconstructible intra-articular distal humerus fractures to avoid arthrodesis.
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Affiliation(s)
- Kirsten Norrell
- Department of Orthopaedic Surgery, University of Missouri Kansas City, Kansas City, Missouri
| | - Derec Stanislav
- Department of Orthopaedic Surgery, Kansas City University/Research Medical Center, Kansas City, Missouri
| | - Micah Sinclair
- Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Caroline Tougas
- Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Toros T, Ozaksar K. Reconstruction of traumatic tubular bone defects using vascularized fibular graft. Injury 2021; 52:2926-2934. [PMID: 31455503 DOI: 10.1016/j.injury.2019.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/10/2019] [Indexed: 02/02/2023]
Abstract
Large segmental bone defects due to major trauma constitute a major challenge for the orthopaedic surgeon, especially when combined with poor or lost soft tissue envelope. Vascularized fibular transfer is considered as the gold standard for the reconstruction of such defects of the extremities due to its predictable vascular pedicle, long cylindrical shape, and tendency to hypertrophy, and resistance to infection. Vascularized bone grafts remain viable throughout the healing period and are capable of inducing rapid graft union without prolonged creeping substitution, osteogenesis and hypertrophy at the reconstruction site, and fight with infection. The fibular graft can be transferred solely, or as a composite flap including muscle, subcutaneous tissue, skin and even a nerve segment in order to reconstruct both bone and soft tissue components of the injury at single stage operation. Such a reconstruction can even be performed in the presence of local infection, since vascularized bone and adjacent soft tissue components enhances the blood flow at the traumatized zone, allowing for the delivery of antibiotics and immune components to the infection site. In an effort to preserve growth potential in pediatric patients; the fibular head and proximal growth plate can be included to the graft. This practice also enables to reconstruct the articular ends of various bones, including distal radius and proximal ulna. Apart from defect reconstruction, vascularized fibular grafts also proved to be a reliable in treating atrophic nonunions, reconstruction of osteomyelitic bone segments. These grafts are superior to alternative reconstructive techniques, as bone grafts with intrinsic blood supply lead to higher success rates in reconstruction and accelerate the repair process at the injury site in cases where blood supply to the injury zone is defective, poor soft tissue envelope, and local infection at the trauma zone.
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Affiliation(s)
- Tulgar Toros
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, 1418 Sok. No: 14 Kahramanlar, 35230 Izmir, Turkey.
| | - Kemal Ozaksar
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, 1418 Sok. No: 14 Kahramanlar, 35230 Izmir, Turkey
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Tarng YW, Lin KC. Management of bone defects due to infected non-union or chronic osteomyelitis with autologous non-vascularized free fibular grafts. Injury 2020; 51:294-300. [PMID: 31718793 DOI: 10.1016/j.injury.2019.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Bone defects as a result of infected non-union or chronic osteomyelitis are difficult to manage. The purpose of this study was to present the results of treatment of bone defects of < 6 cm due to a previous infected non-union or chronic osteomyelitis with autologous non-vascularized fibular grafts in a 2-stage surgery. PATIENTS AND METHODS The records of patients who were treated with autologous non-vascularized fibular grafts for bone defects of < 6 cm due to a previous infected non-union or chronic osteomyelitis between 2008 and 2013 were retrospectively reviewed. Primary complete bone union was the primary outcome. Time until fracture union, and return to normal daily activities or previous work were recorded. Radiographs were evaluated for graft hypertrophy as well as for stress fracture and other complications. RESULTS A total of 27 cases were included. The mean length of the bone defects was 4.4 cm (range 2 - 6 cm). Complete union and healing occurred in 25/27 patients (primary success rate of 92.6%). Non-union was present in two patients with suboptimal soft tissue condition 10 months after surgery, one patient was subsequently treated with a vascularized free fibular graft from the contralateral fibula, and the other patient was treated with distraction osteogenesis, bone union was achieved after the second surgery. Average time to return to normal daily activity after surgery was 7.82 months (6 ~ 11 months). Graft hypertrophy occurred in 15 cases 15/25 (60%) two years post-surgery. There were no other surgical or postoperative complications. CONCLUSIONS With careful evaluation of soft-tissue condition surrounding bone defect, management of infected bone defects with autologous non-vascularized fibular grafts technique has a high success rate with few complications.
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Affiliation(s)
- Yih-Wen Tarng
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung city, Taiwan; Department of Orthopaedics, National Defense Medical Center, Taipei city, Taiwan; Department of Physical Therapy, Shu Zen College of Medicine and Management, Taiwan.
| | - Ki-Chen Lin
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung city, Taiwan; Department of Physical Therapy, Shu Zen College of Medicine and Management, Taiwan
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Agarwal A, Raj RY, Gupta S, Shanker M. Osteosynthesis of Postosteomyelitic Forearm Defects in Children Using a Modified Bone Grafting Technique: The Fibular Intramedullary Bridging Bone and Additional Grafting (FIBBAG). J Hand Surg Asian Pac Vol 2020; 25:13-19. [DOI: 10.1142/s2424835520500010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: There are many options to treat post osteomyelitic gaps in forearm bones. We report a pediatric series with postosteomyelitic forearm segmental defects reconstructed with fibular only graft: the non vascular fibular intramedullary bridging bone and additional grafting (FIBBAG) and the results thereof. Methods: Outcomes in 8 patients treated with fibular strut and overlay matchstick grafts were retrospectively assessed. The clinical results were expressed as forearm shortening, range of motion at elbow and wrist joint. The radiological evaluation included time to union, presence of fractures and recurrence of infection, if any. Results: The average patient age was 6 years (range, 3–12 years). The radius was involved in 6 and ulna in 2. Union occurred in all patients. The average intraoperative gap to be spanned was 5.86 cm (range, 3–14 cm). The average time for union was 6.63 months (range, 2–14 months). Two patients required additional bone grafting procedures. No graft fatigues/fractures were noted in available follow up. There was no recurrence of infection in any case. A positive ulnar variance was seen in 3 patients at follow up. Forearm shortening was a major cosmetic limitation following the procedure. Conclusions: Fibular strut and additional bone grafting (FIBBAG) is one of the viable options for reconstruction of post osteomyelitic forearm defects in children with low procedural complication rate.
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Affiliation(s)
- Anil Agarwal
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | - Rahul Yogendra Raj
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | - Shobhit Gupta
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | - Mukesh Shanker
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
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